Provider Demographics
NPI:1700861739
Name:HEWITT, E CAMERON (MD)
Entity type:Individual
Prefix:DR
First Name:E
Middle Name:CAMERON
Last Name:HEWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDRA
Other - Middle Name:CAMERON
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1731
Mailing Address - Country:US
Mailing Address - Phone:404-297-1780
Mailing Address - Fax:404-252-7255
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-297-1780
Practice Address - Fax:404-252-7255
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057082207Y00000X, 207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1130048OtherAETNA
GA804593303AMedicaid
GA804593303BMedicaid
GA804593303PMedicaid
GA804593303DMedicaid
GA804593303CMedicaid
GA804593303OMedicaid
GA52704119OtherBCBS OF GEORGIA
GA202I043905Medicare PIN
GA1130048OtherAETNA